Floyd Francis Email and Phone Number

Obtain and maintain managed care contracts for Southern Maryland Hospital Center and ancillary companies, including outpatient rehabilitation, family practice, home health services, and durable medical equipment Analyze shared risk contracts and full risk contracts which include negotiating reimbursement and contract language with Managed Care Organizations (MCO)Create new revenue for the Health System by negotiating new contracts and developing new business strategiesAssist in strategic planning for internal network developmentDeveloped and implemented processes for contract negotiation, review, and implementation Implement contracts such as ambulatory surgery, physical therapy, psychiatry, and sleep labMonitor Federal & State legislation to ensure contractual complianceHeavily involved in project management such as the evaluation of utilization of outpatient radiological services and cost analysis of managed care contracts.Cultivate relationships with MCOs and liaison for problem resolutions for Health System, including claim denials, preauthorization requirements, medical necessity, etc.

Resolve complex managed care problems with a goal of satisfying all parties involved and optimizing customer satisfactionAnalysis of state and federal law and their effects on the hospital and its affiliated entities. Escalate issues to upper management as appropriateCreate department procedural manuals in order to streamline internal processesCredential physicians for MCOs participationConduct managed care presentations to various hospital departments on topics regarding the state and trends of managed care and its effects on health care providers.

A liaison between Prudential HealthCare and healthcare providersRecruited and serviced providers in the Commercial, Medicaid, and Medicare Markets. This resulted in an increased number of providers to service membersNegotiated primary care and specialist contracts with individual providersAnalyzed data related to capitation and shared risk contracts and disseminated information to providers to assist them in operating an efficient practiceConducted orientations for healthcare providers as well as monitored and evaluated provider’s performance by analyzing statistical dataAdditional tasks included trouble shooting, problem solving, and handling special projects such as increasing the physician network by 25% within two months by face to face target marketing.Successfully implemented process to pass the survey of the MCO accrediting body, the National Committee of Quality Assurance, which resulted in a 3 year accreditation.